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Monday, April 12, 2010

MiM Mailbag: Anesthesia vs Cardiology (vs OB/GYN?)

Dear MiM,

My name is Taj. Let me just start off by saying I am 100% sure that I am going into the medical field. There's no backing down on my part. I am a highschool junior getting ready to start applying to schools next year and my first choice is the Sophie Davis School of Biomedical Education, a 7yr BS/MD program (not sure if you ladies heard of it). Also any advice you can give on surviving pre-med and medical school I will gladly take :)

I am really interested in anesthesiology and cardiology so my question is really for MommyDoctor and JC. I wanted to know how and when did you ladies juggle and decide when to have kids and also what do you both love about your careers?

MommyDoctor do you work oncall? How did you know you wanted to go into anesthesia and why? What do you love about your job? If you weren't an anesthesiologist what other specialty may you have chosen?

JC what type of cardiologist are you...ex: an interventional cardiologist, cardiac surgeon or just general area cardiology? How did you know you wanted to go into cardiology and why cardiology? Do you think you would have ever gone into cardiac surgery? If so do you think you would still have time to have children? If you weren't a cardiologist what other specialty might you have chosen?

I also have a question for Dr. Whoo.

I actually like babies and the whole aspect of pregnancy and delivery that's how I know no matter what specialty in medicine I choose I want to have kids. But Dr. Whoo how did you come to terms with going into ob/gyn. I think I am interested in it but I am just scared of the malpractice suits.... :( I think that would scare me from going into that specialty.

8 comments:

I know I wasn't specifically addressed, but I just wanted to jump in and say something. Hope that's OK.

I have a different perspective than the contributors you asked, and I hope they weigh in from the point of view as someone who is living with their career choices. I am sure they all have really good things to say about the specialties you are interested in. I am halfway there, and you sparked some thoughts.

Congrats on knowing that you want to do something in the medical field, and good for you for planning and thinking in advance. I am a big advocate for dreaming and planning ahead, because the shlep to the light at the end of the tunnel in medicine is a long one.

I noticed that the three areas you are interested in are quite different types of medicine. Anesthesiology is a completely different life, not just lifestyle, than ob/gyn, with a completely different type of interaction with patients (asleep vs. awake, acute vs. long term).

A thoracic surgeon (9 years of training, general surgery (6)-->thoracic surgery (3) ) is much different that going into internal medicine (3 years) then a cardiology fellowship (another 2 t0 3).

I think you will see which specialty and training requirements suits your temperament and interests the best. I was convinced during my premed that I wanted to be an endocrinologist. But, after spending just a little bit of time with pregnant women, I was sold on ob/gyn and have never looked back. That was after swearing I would never be interested in ob/gyn. But, I haven't done my clinical rotations yet.

I think I could never do anesthesiology, because I love patient interaction and continuity of care (and, frankly, I wouldn't have the grades to go gas if I wanted to). I couldn't do orthopedics because it seems like bicycle repair to me, and I would be miserable. I couldn't do pediatrics, because I would cry all the time. I can barely make it through a lecture about a sick toddler without tearing up.

I am thrilled there are people who are attracted to these other specialties, and hope they love their careers. I would hate for anyone who is ill-suited for ob/gyn to end up there, also. It is a unique area in which you interact with people who are on a wide spectrum of well to sick in a lot of important and highly emotional times in their lives. It is a great balance between surgery and medicine.

I tell people to sign up for email table of contents of the main journals in each field, and glance over them once a month. If the titles excite you, and you want to click through and read the abstracts of at least a few of the articles, then that may be a good field for you. If all else fails, you can try out Fizzy's handy guide to choosing a specialty.

Hi Taj~ I appreciate your question, and I think it is great that you are thinking of lots of different options for your career as you plan for your future. I also have a favorite saying "The best laid schemes o'mice an' men Gang aft agley." or, better known as, "The best laid plans of mice and men often go awry." It is true that we can map out our whole lives on a premise of how we think we want things to be, and find our realities to be so different than what we planned. So really soak in your time in your studies and keep your eyes open, because often I think that our specialty chooses us, rather than the other way around.

As for how I "came to terms" with becoming an Ob/Gyn? I feel that the specialty chose me. That seems really corny and new-agey and carnival psychic-y, but it is true. *I* wanted to choose Dermatology. I really, really wanted to choose it. No call, nice office hours, good compensation, no liability, wide variety of procedures and fields in which to specialize. Instead, I hated every derm clinic I ever attended, got routinely grossed out, came home itching every single day, and ended the rotation with a lovely case of ringworm. So, no derm for me.

Looking back, I think my love for Ob/Gyn started in my first year in our Embryology class. Oh, how I loved this class. I loved reading every thing about it. I aced every test because I *loved* to learn about the way the fetus was formed from just a few cells on up to an honest to goodness human child. Amazing. However, my 3rd year rotation cemented my love for women's health and Ob/Gyn forever. I was in a really busy tertiary care center, got to catch babies right and left, got to scrub in on tons of cases and took a lot of call...and I loved it. I loved the clinic, the surgeries, the babies, and the patients. It was the only subject that I actually looked for material outside the assigned texts so that I could learn more. I just knew this was my field. Did it scare the ever loving be-jeezus out of me? Of course it did! The call, the liability, the long hours away from home all make this specialty less than ideal for a mother in so many ways. There are ways to make it all work. If you love what you do, it makes all the rest of the crap that you go through worth your while.

So, again, go into your studies just as you are, with eyes wide open, and pick something that you truly love to do. The rest will have a funny way of just falling into place. Best wishes! :)

Pathology is really cool. I didn't accept that it was my fate until I had completed the early match for ophthalmology and had spots in some programs. I really didn't want to be a path nerd, really. But now I am glad that I am.

Most would agree that there is a basic personality difference in people who are drawn to surgery v. internal medicine. The medicine people are the thinkers and the surgeons doers. Cardiology however is the most aggressive/ invasive internal medicine specialty.

I am a heart transplant cardiologist. This means that I care for patients with advanced/terminal heart failure. I also care for patients post heart transplant and with Left Ventricular Assist Devices. I love my job because I am able to form close relationships with patients over the course of their illness. I spend time in the clinic, critical care setting and the cath lab. I am an invasive cardiologist, meaning that I perform heart caths and biopsies. I am not an interventional cardiologist, as I do not treat acute MIs (balloons and stents).

When I was a med student I had difficulty choosing between medicine and surgery. (For that reason I also considered OB.) If I was making the decision now (post implementation of work hours rules) I may have chosen surgery. My final decision to do medicine was based on my desire to form closer relationships with my patients, and interest in having a good start with my marriage. I was married one week after med school graduation. [Back in the day CT surgeons took call q3d for the duration of their training. They are now limited to 80 hours per week and 30 consecutive hours.]

Cardiology fellowship is competitive and you must be very dedicated to match in cardiology. Having a baby during training is very possible, but difficult. I started a family after my clinical training. This allowed me to really focus on excelling in my rotations and research.

Only 10% of cardiologists are women (surprising considering 50% of internal med residents are women). My thoughts on this should probably go in a separate post. Even fewer % of CT surgeons are women. Overall I have found being a woman in my field to be an advantage, but I really miss the camaraderie experienced during med school and residency when I was surrounded by female kindred spirits.

Thanks so much for your questions! I think first of all that it important to keep an open mind going into medical school. You get exposed to so many new things, and there are whole fields of medicine that you never contemplated before that you end up learning about. Anesthesia, in fact, was something I thought nothing about and never did a lick of in medical school. I switched into anesthesia after a year of ENT! The fact is that you have to pick a specialty based on limited information (you can't see everything by fall of your 3rd year) and a significant number of people end up switching.

I totally agree with the comment about thinkers versus doers. It does not mean that thinkers can't do and doers don't think, but it says something about your basic tendencies. Do you like to ponder all the options for a while to figure out the best one? Or do you think about something for 10 minutes and decide on a good option, even if you can't confirm it's the absolute best option?

Within that spectrum, anesthesia definitely falls into the doers. I thought about ENT and OB, chose ENT, and then switched into anesthesia. Doer. I love that I'm the one who gets to push the drugs- I think it, I give it, I see the results- no waiting for a nurse to fill the written order.

I also do not think that the assumption is correct that anesthesiologists are somehow antisocial. I love that I have to establish rapport very quickly with people who are at a very stressful time in their lives- about to head into the OR for a surgery. I work with kids, parents, laboring women, awake women having C-sections. Many of the anesthesiologists I know are rather extroverted. But I do like that a portion of my patients do go to sleep, after I have talked to them. It seems to fit my Mommy side- I'll talk to you kid, but after a certain point, I'm the boss. I'm not going to discuss with you if you want your blood pressure controlled or cajol you into taking your medicine- there is a time where I call the shots.

I also really enjoy lots of small procedures- intubations, invasive lines, epidurals, nerve blocks, echocardiography. They are not curative but they are hands-on. It would not be enough for a surgeon, but they are fun for me.

I also love that I get to take care of one patient at a time. No worrying about all the other patients on my service- there's one right into front of me, and I know them literally inside out. I know every drop that has gone in and out. I don't have to juggle daily hematorits in my head for 12 patients over 10 days.

I love physiology. I love giving an intubated patient a big lung-expanding breath and watching the blood pressure transiently dip secondary to decreased venous return. I love sticking the echo probe down the esophagus and watching an empty heart fill with the fluid I'm infusing and the cardiac output rise. I love asking the thoracic surgeon to ligate the right pulmonary artery and instantaneously see the shunt fraction improve. It's cool!

Finally, I would be remiss if I didn't mention that I enjoy that anesthesia allows me to separate work and family life a little more easily. When I leave the hospital, I can pretty much leave work at work- no worrying about this or that patient- they are no longer my direct responsibility. That psychological freedom works well for me.

All that being said, it's not for everyone. Sitting in a room charting vitals on an easy case gets boring for anyone, including me. I think that there are so many intangibles that cause one to pick a specialty- when you rotate as a medical student and meet attendings and residents whom you enjoy and feel comfortable with, you end up wanting to be like them.

I think it's so great that you're starting to ask such good questions. Just remember to stay open-mnded. You might end up at a place you'd never have imagined when you started.

Hi Taj, I want to chime in also. I admire your 100% dedication and getting through the next 7 plus plus years will require that resolve. I was a single mom during med school and residency and, like you, I was 100% committed.

I agree with the above comments that it is too early for you to be choosing a specialty unless you have been exposed to something and know about the work and the lifestyle. It will evolve over time and you will be influenced by professors, mentors, other women (I hope) and the direction your own life takes.

Enjoy the process. The journey can be so fun and will be a highlight in your life. Remember to keep good friends and to play as well as study. Take care of your body and health and stay as well rounded as you can. Good luck

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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